Many people with bipolar disorder also experience symptoms of insomnia and sleep disturbance. Researchers have been investigating treatments for this condition that do not involve medications. After numerous clinical trials, there has been significant success with CBT-I treatment. CBT-I is cognitive behavioral therapy for insomnia and it involves sleep restriction and stimulus control.
The purpose of the first treatment is to establish a consistent schedule for bedtimes and rise times. In addition, throughout the treatment, patients need to keep track of fluctuations in mood and sleepiness throughout the day.
It is common for bipolar patients to report either insomnia or hypersomnia in the midst of a manic or depressive phase. These changes in sleep patterns are usually a warning sign for the occurrence of a mood episode and can also induce a relapse.
To help people with bipolar that struggle with insomnia, the first part of the treatment is stimulus control. Stimulus control includes:
– Using the bed and bedroom for only sleep and sex
– Going to bed only when sleepy
– Leaving the bedroom if you are unable to fall asleep or return to sleep within 15-20 minutes
– Arising at the same time each morning
The goal of stimulus control is to increase sleep efficiency, which is the amount of total sleep divided by the time spent in bed. Each person has a sleep window, or time spent asleep in bed, which is reviewed weekly. This sleep window is adjusted each week to maximize sleep efficiency, and ideally over time the sleep window will increase to optimal sleep time.
Before beginning treatment, each patient is evaluated to make sure that CBT-I is the right fit for him or her. There are 8 therapy sessions where the individual’s case is discussed to create an appropriate plan of action. The sleep restriction is introduced in the second session and the stimulus control begins immediately after.
At the start of each session, the patient’s mood is evaluated.
Most patients experienced positive results from the treatment. If participating in CBT-I, there are some treatment recommendations. Patients are encouraged to monitor sleep regularly and be aware of the times they fall asleep and wake up. This way they can better evaluate their progress. Patients should also monitor symptoms of depression and mania and sleepiness. Creating a sleep schedule for weekdays and weekends can help patients maintain regular sleep patterns. To stay on track, it is helpful to inform family and friends of bedtimes and rise times, so they do not call or create a disturbance that would interfere with the sleep schedule. If a patient is finding it difficult to stay on track, it is recommended that positive reinforcement rewards be used to keep up with treatment.
Even at the end of treatment, patients are encouraged to continue sleep restriction and stimulus control to prevent the return of insomnia. For more information, the full article is called Sleep Restriction in Bipolar and can be found in the American Journal of Psychiatry 2013. In addition, a similar program can be found by going to the website of SHUTi.